Unusual Stroke Mimics: What Else Could It Be?

A stroke is a serious medical condition that requires immediate attention. However, several conditions can mimic the symptoms of a stroke, known as stroke mimics. These conditions can present similar symptoms to a stroke, such as weakness, difficulty speaking, vision changes, and dizziness, but are not vascular in nature. Stroke mimics include seizures, migraines, psychiatric disorders, brain tumours, metabolic conditions like hypoglycemia, and functional neurological disorders. While it is crucial to seek immediate medical attention for stroke-like symptoms, being aware of stroke mimics can help prevent misdiagnosis and ensure appropriate treatment.

Characteristics	Values
Seizures	Weakness in one arm or leg, numbness, tingling, temporary confusion, or loss of consciousness
Migraines	Temporary facial paralysis, blurred vision, slurred speech, or weakness or numbness in the arms or legs
High or low blood sugar	Dizziness, shakiness, irregular heartbeat, severe headache, blurred vision, weakness, feeling out of it
Bell's Palsy	Sudden facial weakness, mouth drooping, drooling or trouble closing one eye
Brain tumour	Loss of coordination, trouble speaking or seeing, weakness in arms or legs, confusion
Multiple sclerosis	Numbness, tingling, muscle weakness, vision loss, impaired coordination
High blood pressure	Dizziness, numbness, tingling, weakness
Psychiatric disorders	N/A
Hypoglycaemia	N/A
Syncope	N/A
Sepsis	Confusion, difficulty thinking, focusing, moving, speaking, or seeing
Encephalitis	N/A

Seizures

It is important to note that seizures themselves can be a symptom of an underlying neurological or psychiatric disorder, such as epilepsy or a psychiatric disorder. In some cases, seizures may be triggered by factors such as electrolyte disturbances or the use of certain medications.

If you or someone you know is experiencing symptoms of a seizure or stroke, it is crucial to seek immediate medical attention. Do not delay treatment, as prompt care is essential for improving outcomes and reducing the risk of long-term complications.

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Migraines

People with hemiplegic migraines may experience temporary paralysis on one side of the body, a symptom called hemiplegia. This paralysis is usually preceded by auras, which are early symptoms that affect muscle control and sensation. Auras can also cause a pins-and-needles feeling, often moving from the hand up the arm, as well as numbness on one side of the body, including the arm, leg, and half of the face.

Other symptoms of hemiplegic migraines include:

Throbbing pain, often on one side of the head
Loss of balance and coordination
Dizziness or vertigo
Visual disturbances such as zigzag lines, double vision, blind spots, flashing lights, or shimmering, jagged lines
Extreme sensitivity to light, sound, and smell
Language difficulties, such as mixing words or trouble remembering words
Drowsiness or loss of consciousness

It's important to note that hemiplegic migraine symptoms typically come on slowly and may completely go away, whereas stroke symptoms usually appear abruptly and simultaneously. Additionally, muscle problems associated with hemiplegic migraines usually resolve within 24 hours but may last a few days.

If you suspect you or someone else is having a stroke, it is crucial to call for emergency medical assistance immediately. While stroke mimics can present similar symptoms, a stroke is a medical emergency that requires prompt treatment to prevent brain damage and potential disability.

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Psychiatric disorders

Stroke mimics, including psychiatric disorders, can present with similar symptoms to a stroke such as sudden weakness, difficulty speaking, vision changes, and dizziness. Psychiatric disorders that mimic stroke can be functional (conversion) disorders or part of the symptomatology of a neurological or medical disorder. Functional mimics are less frequent but can be difficult to differentiate from an ischemic stroke. They often present with inconsistent findings on repeated examinations and may have a previous history of psychiatric disorders, migraines, seizures, or depression.

The diagnosis of psychiatric disorders as stroke mimics is particularly important as it can lead to the inappropriate use of expensive and potentially harmful medications, such as thrombolysis and antithrombotic therapy. It can also result in unnecessary costs and prolonged observation in high-intensity units. Additionally, misdiagnosis can lead to the incorrect lifetime use of stroke prevention medication and the associated psychosocial problems and insurance implications.

The clinical examination remains the most important tool for distinguishing between a stroke and a psychiatric disorder. Certain clinical features may suggest a psychiatric disorder, such as inconsistent findings on examination, downward drift of the arm without pronation, and gaze deviation. Advanced brain imaging, such as magnetic resonance imaging (MRI), can also be helpful in making a precise diagnosis, especially when combined with clinical evaluation.

The treatment of psychiatric disorders mimicking stroke depends on the underlying condition. Early psychiatric intervention is often required, and recurrence is common. It is important to provide reassurance to the patient that there is no structural lesion causing their symptoms and to offer psychiatric consultation.

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Brain tumours

Changes in personality can also be a symptom of both strokes and brain tumours, occurring when the frontal lobe of the brain is affected. The person may become more impulsive or apathetic, suffer from mood swings, or lash out at those around them for no apparent reason.

It is important to note that brain tumours and strokes require different treatments, so accurate diagnosis is crucial. Brain tumours do not typically cause headaches, contrary to popular belief. Instead, a constant pressure in the head may suggest an issue, but not episodic experiences of pain.

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Multiple sclerosis

The symptoms of MS can sometimes mimic those of a stroke. MS patients may experience problems with their vision, such as blurred vision or even temporary loss of sight. They may also have numbness and tingling sensations, muscle weakness, and impaired coordination. These symptoms can lead to difficulties with walking, speaking, and moving, which are also common indicators of a stroke.

However, there are some key differences between MS flares and strokes. MS flares typically occur over several days, whereas stroke symptoms are abrupt and severe and can occur within minutes. Additionally, an MRI scan can help distinguish between the two conditions, as stroke lesions look different from MS lesions.

It is important to note that people with MS who have risk factors for stroke, such as hypertension, heart disease, smoking, diabetes, and high cholesterol, are at an increased risk of developing a stroke. Therefore, it is crucial for MS patients experiencing stroke-like symptoms to seek medical attention promptly to determine the underlying cause.